Current pre-hospital traumatic brain injury management in China

BACKGROUND Traumatic brain injury (TBI) is associated with mo st trauma-related deaths. Secondary brain injury is the leading cause of in-hospital deaths after traumatic brain injury. By early prevention and slowing of the initial pathophysiological mechanism of secondary brain injury, pre- hospital service can signifi cantly reduce case-fata lity rates of TBI. In China, the incidence of TBI is increasing and the proportion of severe TBI is much higher than that in other countries. The objective of this paper is to review the pre-hospital management of TBI in China. DATA SOURCES A literature search was conducted in January 2014 using the China National Knowledge Infrastructure (CNKI). Articles on the assessment and treatment of TBI in pre-hospital settings practiced by Chinese doctors were identified. The information on the assessment and treatment of hypoxemia, hypotension, and brain hern iation was extracted from the identifi ed articles. RESULTS Of the 471 articles identified, 65 met the selecti on criteria. The existing literature indicated that current practices of pre-hospital TBI management in China were sub-optimal and varied considerably across different regions. CONCLUSION Since pre-hospital care is the weakest part of Chinese emergency care, appropriate training programs on pre-hospital TBI management are urgently needed in China.

Practices and knowledge levels of prehospital doctors in traumatic brain injury management in Hubei, China

This thesis is a cross-sectional questionnaire survey of pre-hospital doctors' knowledge and practice of managing traumatic brain injury in two major cities of Hubei province, China. This study provides evidence for future research on improving the quality of pre-hospital management in China.

Urinary biomolecular indicators of exercise-induced over exertion injury

Poor health and injury represent major obstacles to the future economic security of Australia. The national economic cost of work-related injury is estimated at $57.5 billion p/a. Since exposure to high physical demands is a major risk factor for musculoskeletal injury, monitoring and managing such physical activity levels in workers is a potentially important injury prevention strategy. Current injury monitoring practices are inadequate for the provision of clinically valuable information about the tissue specific responses to physical exertion. Injury of various soft tissue structures can manifest over time through accumulation of micro-trauma. Such micro-trauma has a propensity to increase the risk of acute injuries to soft-tissue structures such as muscle or tendon. As such, the capacity to monitor biomarkers that result from the disruption of these tissues offers a means of assisting the pre-emptive management of subclinical injury prior to acute failure or for evaluation of recovery processes. Here we have adopted an in-vivo exercise induced muscle damage model allowing the application of laboratory controlled conditions to assist in uncovering biochemical indicators associated with soft-tissue trauma and recovery. Importantly, urine was utilised as the diagnostic medium since it is non-invasive to collect, more acceptable to workers and less costly to employers. Moreover, it is our hypothesis that exercise induced tissue degradation products enter the circulation and are subsequently filtered by the kidney and pass through to the urine. To test this hypothesis a range of metabolomic and proteomic discovery-phase techniques were used, along with targeted approaches. Several small molecules relating to tissue damage were identified along with a series of skeletal muscle-specific protein fragments resulting from exercise induced soft-tissue damage. Each of the potential biomolecular markers appeared to be temporally present within urine. Moreover, the regulation of abundance seemed to be associated with functional recovery following the injury. This discovery may have important clinical applications for monitoring of a variety of inflammatory myopathies as well as novel applications in monitoring of the musculoskeletal health status of workers, professional athletes and/or military personnel to reduce the onset of potentially debilitating musculoskeletal injuries within these professions.

Pre-Admission and Post-Hospital Management of Heart Failure in Patients not Enrolled in Specialist Programs

Aim: To review the management of heart failure in patients not enrolled in specialist multidisciplinary programs. Method: A prospective clinical audit of patients admitted to hospital with either a current or past diagnosis of heart failure and not enrolled in a specialist heart failure program or under the direct care of the cardiology unit. Results: 81 eligible patients were enrolled (1 August to 1 October 2008). The median age was 81 9.4 years and 48% were male. Most patients (63%) were in New York Heart Association Class II or Class III heart failure. On discharge, 59% of patients were prescribed angiotensin converting enzyme inhibitors and 43% were prescribed beta-blockers. During hospitalisation, 8.6% of patients with a past diagnosis of heart failure were started on an angiotensin converting enzyme inhibitor and 4.9% on a beta-blocker. There was evidence of suboptimal dosage on admission and discharge for angiotensin converting enzyme inhibitors (19% and 7.4%) and beta-blockers (29% and 17%). The results compared well with international reports regarding the under-treatment of heart failure. Conclusion: The demonstrated practice gap provides excellent opportunities for the involvement of pharmacists to improve the continuation of care for heart failure patients discharged from hospital in the areas of medication management review, dose titration and monitoring.

The use of supply chain management to reduce delays as result of pre-construction deficiencies in Malaysian public sector construction projects

This thesis examined the delay causes of Malaysian public sector projects. Using a systematic approach, the researcher identified the main delay factors and categorised them into pathogens. The pathogens were matched with beneficial Supply Chain Management (SCM) tools and developed into a holistic SCM framework to facilitate improvements in Malaysian public sector projects. The researcher concluded that SCM is the potential saviour for the delay dilemma and that it is necessary for the Malaysian government to initiate the revolutionary practice.

Pre-operative nutritional support in children with end-stage liver disease accepted for liver transplantation: An approach to management

Pre-operative nutritional support was studied in 28 children with end-stage liver disease awaiting orthotopic liver transplantation. Nasogastric supplemental administration of a standard semi-elemental enteral nutritional formula was compared with a similar formula enriched with branched chain amino acids, and with a group receiving oral nutrition only. The duration of treatment in all groups was similar (mean 90 days). Energy intakes in the supplemented groups were 120-150% of recommended daily intakes (RDI), whereas ad libitum intakes in the oral group ranged 58-100% RDI. A significant improvement in mean Z-score for body weight (denoting catch-up) was noted only in those children who received nasogastric supplements enriched with branched-chain amino acids. The standard enterally-fed group maintained their body weight and Z-scores did not change significantly. In contrast, body weight Z-scores in those fed orally declined significantly. Nutritional supportive therapy of malnourished children with end-stage liver disease can minimize or improve nutritional status in children awaiting liver transplantation. The use of nutritional formulae rich in branche-chain amino acids may have nutritional advantages in children with chronic liver disease which require further study and evaluation.

Supporting pre-tender construction planning with virtual prototyping

Purpose – Virtual prototyping technologies linked to building information models are commonplace within the aeronautical and automotive industries. Their use within the construction industry is now emerging. The purpose of this paper is to show how these technologies have been adopted on the pre-tender planning for a typical construction project. Design/methodology/approach – The research methodology taken was an “action research” approach where the researchers and developers were actively involved in the production of the virtual prototypes on behalf of the contractor thereby gaining consistent access to the decisions of the planning staff. The experiences from the case study were considered together with similar research on other construction projects. Findings – The findings from the case studies identify the role of virtual prototyping in components modelling, site modelling, construction equipment modelling, temporary works modelling, construction method visualization and method verification processes. Originality/value – The paper presents a state-of-the-art review and discusses the implications for the tendering process as these technologies are adopted. The adoption of the technologies will lead to new protocols and changes in the procurement of buildings and infrastructure.

Management of sharps in ambulance care : a state-wide survey of paramedic knowledge and reported practice

Paramedics are at high risk of exposure to infectious diseases because they frequently undertake procedures such as the use and disposal of sharps as components of everyday practice. While the literature demonstrates that the management of sharps is problematic across all health disciplines, there is a paucity of research examining sharps management practices in the Australian pre-hospital paramedic context. This study examines knowledge and practices of sharps control among paramedics in Queensland, Australia. A mail survey focusing on infection control knowledge and practices was sent to all clinical personnel of the Queensland Ambulance Service (QAS) (N = 2274). A total of 1258 surveys were returned, a response rate of 55.3%. Participants responded to 12 true/false statements on the management of sharps and three questions about recapping practices. Most respondents were knowledgeable about the correct management of sharps, with a mean of 11.28 (out of 12, SD = 1.32). When gauging reported practices, more than half (59.1%, n = 736) of participants reported recapping a needle, and 38.5% (n = 479) reported never having done so. These results reflect good knowledge of general management of sharps among respondents, but suggest deficits regarding reported practices. The results suggest that a comprehensive ambulance in-service education programme focusing particularly on sharps management is required. The study highlights the need for further research on sharps management practices in the field, identification of barriers to safe sharps practices in pre-hospital settings, and 'best practice' for translating good sharps management knowledge into practice.

Before the first export decision : internationalisation readiness in the pre-export phase

Although the internationalisation process of the firm has been well researched since the 1970s, the behaviour of firms prior to internationalisation has not received commensurate research attention.This paper argues that a focus on firms’ pre-internationalisation activities will not only offer an additional important perspective to the study of firm internationalisation but it will also address a significant research gap in studies that are theoretically based on the so-called stages models. During the pre-internationalisation phase, a firm is exposed to stimuli factors that may trigger an impulse for foreign market expansion. Decision makers’ perceptions of stimuli, their attitudinal commitment towards internationalisation, the firms’ resources and capabilities, as well as the mediating effect of lateral rigidity comprise a learning process that leads a firm towards readiness to initiate an internationalisation decision. This paper advances the concept of internationalisation readiness and proposes a method for developing an Internationalisation Readiness Index.

A fuzzy neural network approach for contractor pre-qualification

Nonlinearity, uncertainty and subjectivity are the three predominant characteristics of contractors prequalification which cause the process more of an art than a scientific evaluation. A fuzzy neural network (FNN) model, amalgamating both the fuzzy set and neural network theories, has been developed aiming to improve the objectiveness of contractor prequalification. Through the FNN theory, the fuzzy rules as used by the prequalifiers can be identified and the corresponding membership functions can be transformed. Eighty-five cases with detailed decision criteria and rules for prequalifying Hong Kong civil engineering contractors were collected. These cases were used for training (calibrating) and testing the FNN model. The performance of the FNN model was compared with the original results produced by the prequalifiers and those generated by the general feedforward neural network (GFNN, i.e. a crisp neural network) approach. Contractor’s ranking orders, the model efficiency (R2) and the mean absolute percentage error (MAPE) were examined during the testing phase. These results indicate the applicability of the neural network approach for contractor prequalification and the benefits of the FNN model over the GFNN model. The FNN is a practical approach for modelling contractor prequalification.

Decision support system for contractor pre-qualification : artificial neural network model

The selection criteria for contractor pre-qualification are characterized by the co-existence of both quantitative and qualitative data. The qualitative data is non-linear, uncertain and imprecise. An ideal decision support system for contractor pre-qualification should have the ability of handling both quantitative and qualitative data, and of mapping the complicated nonlinear relationship of the selection criteria, such that rational and consistent decisions can be made. In this research paper, an artificial neural network model was developed to assist public clients identifying suitable contractors for tendering. The pre-qualification criteria (variables) were identified for the model. One hundred and twelve real pre-qualification cases were collected from civil engineering projects in Hong Kong, and eighty-eight hypothetical pre-qualification cases were also generated according to the “If-then” rules used by professionals in the pre-qualification process. The results of the analysis totally comply with current practice (public developers in Hong Kong). Each pre-qualification case consisted of input ratings for candidate contractors’ attributes and their corresponding pre-qualification decisions. The training of the neural network model was accomplished by using the developed program, in which a conjugate gradient descent algorithm was incorporated for improving the learning performance of the network. Cross-validation was applied to estimate the generalization errors based on the “re-sampling” of training pairs. The case studies show that the artificial neural network model is suitable for mapping the complicated nonlinear relationship between contractors’ attributes and their corresponding pre-qualification (disqualification) decisions. The artificial neural network model can be concluded as an ideal alternative for performing the contractor pre-qualification task.

Will they know enough? Pre-service primary teachers' knowledge base for teaching intergrated social sciences

A significant issue in primary teacher education is developing a knowledge base which prepares teachers to teach in a range of subject areas. In Australia, the problem in primary social science education is compounded by the integrated nature of the key learning area of Studies of Society and Environment (SOSE). Recent debates on teaching integrated social sciences omit discussions on the knowledge base for teaching. In this paper, a case study approach is used to investigate primary pre-service teachers’ approaches to developing a knowledge base in designing a SOSE curriculum unit. Data from five teacher-educators who taught primary SOSE curriculum indicates that novice teachers’ subject content knowledge, as revealed through their curriculum planning, lacked a disciplinary basis. However, understanding of inquiry learning, which is fundamental to social science education, was much stronger. This paper identifies a gap in the scholarship on teaching integrated social science and illustrates the need to support and develop primary teachers’ disciplinary knowledge in teacher education.

Using microteaching to enhance teacher efficacy in pre-service teachers

This study examined pre-service teachers’ efficacy in relation to the utilisation of microteaching as an assessment tool for postgraduate education students in Australia. Three hundred and fifteen pre-service teachers completed the teacher efficacy survey and additional qualitative questions at Time 1 and 208 completed the survey and questions at Time 2. A principal components analysis conducted on the Time 1 survey data revealed teacher efficacy to be comprised of two components: ‘teacher efficacy in classroom management’ and ‘personal teacher efficacy’. Repeated measures ANOVAs conducted on the 208 participants who completed the survey at Time 1 and 2 revealed that efficacy on both components increased significantly over time, and that internet students had higher efficacy levels than internal students. The qualitative data revealed that pre-service teachers enter teaching in order to positively impact on children, yet are concerned about behaviour management in the classroom. In addition, this data highlighted the positive impact that microteaching had on their developing teacher identity.